Provider Demographics
NPI:1881174670
Name:SLAGLE, CARLY STAPLETON (RD)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:STAPLETON
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:AMANDA
Other - Last Name:STAPLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 FORT SANDERS WEST BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3352
Mailing Address - Country:US
Mailing Address - Phone:865-539-0270
Mailing Address - Fax:865-539-6998
Practice Address - Street 1:280 FORT SANDERS WEST BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3352
Practice Address - Country:US
Practice Address - Phone:865-539-0270
Practice Address - Fax:865-539-6998
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered